Role of fibronectin in immune glomerulonephritis.

There is already a considerable amount of evidence suggesting that fibronectin (Fn) plays an important role in the pathogenic process in some forms of glomerulonephritis (GN). It has been postulated that Fn may participate in the progression or regression of glomerular diseases. The Fn is presented in the kidney as a normal component of the mesangium, and it is increased in the expanded mesangium in various forms of GN. This paper reports our efforts to investigate the role of Fn in plasma and kidney in patients with GN. Using monoclonal antibodies against human Fn in the ELISA and immunohistoperoxidase techniques to evaluate Fn, we investigated its quantity in connection with clinical state and morphological findings. We studied 93 patients with GN and 26 renal biopsies. The patients with active forms of mesangial proliferative, membranoproliferative and membranous GN showed increased plasma Fn, and the highest levels were in patients with nephrotic syndrome. Increased tissue Fn correlated with mesangial expansion and with IgG and C3 deposits. We speculate on possible mechanisms of the involvement of Fn in human chronic GN.

[Mesangial C3-glomerulonephritis]. / Mezangialen C3-glomerulonefrit.

12 patients with mesangial C3-glomerulonephritis, 7 women and 5 men, aged 16-42, mean age 29.7 years, were followed up for 1-18 years, mean time 5.7 years. The disease was manifested most often by macroscopic hematuria or low degree proteinuria. Single patients had arterial hypertension. In only one patient there was a nephrotic syndrome. For the period of observation, impairment of the renal function was found in none of the patients.

[Gemfibrozil in the treatment of hyperlipoproteinemias]. / Gemfibrozil pri ledchenie na khiperlipoproteinemiite.

30 patients with primary hyperlipoproteinemia (type II and IV according to Fredrickson) were treated with Gemfibrosil (Gevinon--film tablets of 450 mg of "Parke-Davis Company") for a period of 45 days with a daily dose of two tablets taken with the evening meal. The results of the treatment were a decrease of the total cholesterol (with 16.34%), of triglycerides (with 34.50%), of low density lipoproteins (with 10.76%) and of very low density lipoproteins (with 49.21%) and an increase of the high density lipoproteins (with 2.34%). Gevilon was well tolerated. No side effects requiring discontinuing of the treatment were registered.

[A clinico-therapeutic study of the Bulgarian preparation fupiram]. / Kliniko-terapevtichno prouchvane na bulgarskiia preparat fupiram.

The study includes 30 patients: 21 patients with various cardiac diseases which had led to chronic cardiac failure with well expressed edemas, 7 patients with liver cirrhosis and ascites, 2 patients with chronic glomerulonephritis and nephrotic syndrome. For 7 consecutive days the patients received fupyram or furanthril. In the morning, before breakfast, they received either 1 capsule fupyram (which is composed of amyloride hydrochloride 0.005 g and furezemide 0.04 g) or 1 tablet furanthril. In case of insufficient diuresis the daily dose was increased to 2 capsules fupyram (or 2 tablets furanthril respectively). In the patients with satisfactory diuretic effect the dose was reduced to 1 capsule (tablet) every other day or 2 capsules 2 times weekly after the second week. At the end of the 4-th week the general condition of the patients improved considerably. The diuresis increased, the body mass and the arterial pressure decreased. The potassium serum level increased from 4.4 +/- 0.3 mmol/l at the beginning of the treatment to 5.3 +/- 0.7 mmol/l. In 11 patients the potassium level reached values about 5.5 mmol/l. The drug fupyram exerts a pronounced diuretic efficacy. In the patients with preserved renal function fupyram does not change significantly the potassium serum level, but in patients with impaired renal function it can lead to hyperkalemia even after an unprolonged treatment.

[Drug disease related to the use of nonsteroidal anti-inflammatory agents]. / Lekarstvena bolest vuv vruzka s upotreba na nesteroidni protivovuzpalitelni sredstva.

A case is presented of a woman with drug disease related to the use of non-steroid antiinflammatory drugs. The disease was manifested by combined impairment of several organs and systems: arthralgia, febrility, anorexia, fibroscopic data for superficial gastritis, iron deficiency anemia, angiospastic syndrome, impairement of the liver and the kidneys. The renal lesions differed from the usual for such cases tubulointerstitial changes and a mild mesangioproliferative glomerulonephritis without manifested clinical symptoms was found. Discontinuance of the treatment with the non-steroid antiinflammatory drugs lead to the disappearance of the complaints and normalization of all laboratory indices.

[Gordon's syndrome--a combination of hyperkalemia and arterial hypertension with preserved kidney function]. / Sindrom na Gordon--suchetanie na khiperkaliemiia s arterialna khipertoniia pri zapazena bubrechna funktsiia.

A case of Gordon's syndrome in a 38 years old man is presented--hyperpotassemia and arterial hypertension with preserved renal function, normal supra-adrenal function, no data for hemolysis, normal coagulation state, mild compensated metabolic acidosis. Renal tubular defect, for excretion of potassium and chlorides, sodium reabsorption, tubular resistance to mineralocorticoids are discussed. The combination of hyperpotassemia and arterial hypertension might be due to phenotype manifestations of a single gene.

[Treatment of chronic glomerulonephritis with high doses of intravenous immunoglobulin]. / Lechenie na khronichnite glomerulonefriti s visoki dozi intravenozen imunoglobulin.

The initial results of the treatment of 8 patients with idiopathic and lupus glomerulonephritis with immunovenin intact are reported. Previously the patients had been treated for a long time with combinations of corticosteroids, immunosuppressors and anticoagulants without effect. All patients had an well expressed nephrotic syndrome, 6 patients had initial chronic renal failure. The immunovenin intact treatment was carried out in three day courses of 85 mg/kg/24 h (a total of 250 mg/kg for one course). All patients received two courses of treatment. The patients were followed up for 3 to 30 months (mean 10.0 +/- 3.29). In 4 patients a full clinical remission was achieved. Two patients, after a satisfactory effect of the treatment, died from non-renal causes. The mechanisms of action of immunovenin intact are discussed.

[A case of xanthogranulomatous pyelonephritis]. / Edin sluchai s ksantogranulomatozen pielonefrit.

A case of a 38 years old man with xanthogranulomatous pyelonephritis is presented. The ultrasound examination of the abdomen found a tumorous formation above the left kidney. Arterial hypertension and changes in the lipid metabolism were found clinically. The i. v. urography revealed more characteristic changes. The diagnosis xanthogranulomatous pyelonephritis is based on the computed tomography findings and the clinico-laboratory examinations.

[Hypokalemic nephropathy from the chronic use of diuretics and laxatives]. / Khipokaliemichna nefropatiia pri khronichna upotreba na diuretitsi i slabitelni lekarstva.

The cases of two women with morphologically proved hypokalemic nephropathy related to chronic use of diuretics and purgatives are reported. The disease has been detected because of reduced urine quantity, increase of body mass and edema. The serum protein level is low. Sodium and potassium clearances are reduced. There is a metabolic alkalosis, serum renin and aldosterone levels are elevated. The histologic picture is typical with tubule cell vacuolization and sclerotic changes in the interstitium. The timely discovery of the cause of the disease leads to the discontinuance of the use of diuretics and purgatives and to complete recovery.

[The late results of treating membranous glomerulonephritis]. / Kusni rezultati ot lechenieto na membranozniia glomerulonefrit.

27 patients with membranous glomerulonephritis treated with corticosteroids, anticoagulants and some with immunosuppressors are discussed. Men prevailed. Nephrotic syndrome proved by renal biopsy was found in 88.9%, proteinuria under 3.5 g/24 h--in 11.1%, arterial hypertension--in 18.5%, renal failure--in 14.8% of the patients. At the end of the follow up 15 patients (55.6%) showed a complete remission and 4 patients a partial remission. In 8 patients (29.6%) there was chronic renal failure and three of them had gone through hemodialysis. Comparing the patients with and without chronic renal failure we found that only the presence of impaired renal function as found by renal biopsy and the greated duration of the disease are of statistically significant importance for the prognosis of membranous glomerulonephritis. A 5 year survival of the patients treated actively is 100% and a 10 year survival is 94.9% which allows the assumption that treatment of membranous glomerulonephritis can lead to a permanent remission and preservation of renal function.

[The survival of patients with mesangial immunoglobulin A glomerulonephritis]. / Prezhiviaemost pri bolnite s mezangealen imunoglobulin A glomerulonefrit.

68 patients with immunoglobulin A glomerulonephritis (IgA-GN) were studied. 67.4% of them were men. The most frequent clinical manifestation is the microscopical hematuria--in 39.7% of the patients. A single episode of macroscopic hematuria was found in 32.3% of the patients and recurrent macroscopic hematuria--in 25% of the patients. Proteinuria was found in all patients but nephrotic syndrome--only in one patient. At the time of the biopsy 35.5% of the patients were with hypertension, 13.2%--with initial chronic renal failure. The survival of the patients with IgA--GN, assessed according to the registration life tables, was 93% at the 5-th year, 88% at the 10-th year and 70.6% at the 20-th year. It was statistically higher in the patients without hypertension. Among the patients with proteinuria below 1.0/24 h no one reached terminal chronic renal failure. The male sex was a factor for a statistically shorter survival only at the 20-th year. The survival of the patients with insignificant histological changes was 100% for the period of the study, whereas it was significantly lower for the other histological variants. According to the data of the study, the presence of arterial hypertension, proteinuria above 1.0 g/24 h, a more severe histological variant (focal-segment, diffuse proliferative and particularly sclerotic), and to a certain degree the male sex play an unfavorable role in the survival and determine a poorer prognosis for the patients with IgA-GN.

[Benign monoclonal gammopathy in a female patient with Schönlein-Henoch glomerulonephritis and liver cirrhosis]. / Dobrokachestvena monoklonalna gamapatiia pri bolna s Schönlein--Henoch glomerulonefrit i chernodrobna tsiroza.

A case of a woman with Schönlein-Henoch glomerulonephritis and liver cirrhosis and a monoclonal peak in the proteinogram is reported. An attempt is made to differentiate the benign monoclonal gammapathy from Waldenström's disease according to the existing criteria. The conclusion is reached that at present there is no index or a combination of indices which could allow a definite assessment. Only the prolonged systematic observation with repeated examinations could allow a more precise assessment of the pathologic process.

[The effect of treatment on the survival rate in chronic glomerulonephritis]. / Efekt na lechenieto vurkhu prezhiviaemostta pri khronichnite glomerulonefriti.

The survival rate of 68 patients with immunoglobulin A glomerulonephritis (IgA GN), 29 patients with membranous glomerulonephritis (MGN), 13 patients with membranous-proliferative glomerulonephritis (MPGN) and 40 patients with lupus glomerulonephritis (LGN) was assessed using the life registration tables. The patients with IgA GN were treated symptomatically, and the remaining patients were treated with a combination of corticosteroids, immunosuppressors and anticoagulants. At the 10th year from the onset of the disease the survival rate was as follows: for the patients with IgA GN--88%, with MGN--94.9%, with LGN--81.0% and with MPGN--61.6%. The comparison with the survival rate established for the respective types of glomerulonephritis without treatment or the presence of mixed groups of treated and nontreated patients shows that the combined pathogenetic treatment improves the prognosis of MGN, LGN and of a number of patients with MPGN and it nears that of the comparatively more benign IgA GN.

[Guanfacine in the treatment of arterial hypertension in diabetics]. / Guanfatsin pri lechenie na arterialnata khipertoniia u diabetno bolni.

30 patients with hypertension and diabetes mellitus type II were treated with guanfacine (Estulic--"Sandoz" Switzerland) 1 mg tablets in the course of 6 months. The trial began with a placebo period at the end of which the patients were classified into groups: I groups--mild hypertension--14 patients, II group--moderate hypertension--8 patients and III group--severe hypertension - 8 patients. The treatment began in all patients with 0.5 mg Estulic once a day in the evening. According to the effect the dose was increased in one week intervals to 1, 2 and 3 mg daily. A very good effect was achieved in 24 patients (80%), good effect--in 3 patients (10%). There was no effect in 3 patients (10%) with diastolic pressure at the end of the placebo period of 15.3 kP (115 mm Hg). The drug Estulic did not deteriorate the glucose tolerance and in 22 patients (73.3%) a decrease of the blood sugar levels with mean 3.47-1.98 mmol/l was found.